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TB Follow-Up Worksheet A. Demographic Information Version[removed]
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Document Date: 2013-10-28 16:21:53

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File Size: 18,59 KB

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Company

U.S Review / Up Worksheet (Cont) U.S. Review / /

Country

United States / /

Event

Product Issues / /

Facility

AFB Smear Result Not Done Positive Negative Unknown / Stable Unknown Worsening Improving Cavity Fibrosis Granuloma / Station Phone / Clinic Name / /

MedicalCondition

TB infection / TB / Verifiable Abnormal Poor Quality Infiltrate Cavity Granuloma / /

Position

Physician / Panel Physician / Officer / /

Product

INH / /

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